Emily Michelle Wise, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

254256 Issued in MA

Practice address

20 William St Ste G15
Wellesley, MA 02481-4102

Phone

(781) 591-4234

Fax

(781) 369-9737

NPI assigned

Jun 30, 2009

Reactivated

Jan 8, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dermatology

Education

Boston University School of Medicine, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dermwellesley LLCGroup PAC ID 1850644071, 9 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: wise.emily.mkdmd@direct.partners.masshiway.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dermwellesley LLC

  • Dermatology Physician
  • Wellesley, MA
  • NPI 1811478092

  Single Specialty

  Medicare reassignment Care Compare group NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1246320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546905600000",
    "number": "1487882270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 WILLIAM ST STE G15",
            "city": "WELLESLEY",
            "state": "MA",
            "postal_code": "024814102",
            "telephone_number": "781-591-4234",
            "fax_number": "781-369-9737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 WILLIAM ST STE G15",
            "city": "WELLESLEY",
            "state": "MA",
            "postal_code": "024814102",
            "telephone_number": "781-591-4234",
            "fax_number": "781-369-9737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISE",
        "first_name": "EMILY",
        "middle_name": "MICHELLE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-06-30",
        "last_updated": "2019-01-08",
        "deactivation_date": "2019-01-03",
        "reactivation_date": "2019-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "MA",
            "license": "254256",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MA",
            "license": "254256",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1487882270",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Beth G Wilson, LICSW
• Kalin Wilson
• Rachel Elizabeth Wilson, FNP-BC
• Richard Marsh Wilson, PSY.D.
• Fern Wirth, M.D.
• Amanda Wislocki-Wasecki, LICSW
• Daniel Ritz Witt, MD
• Lynn Wittman, OD
• Amy Woiszwillo, RDH
• Michael Wolchonok, M.D.

• Dermatology Physician in Wellesley, MA
• Providers in Wellesley, MA by specialty
• Dermatology Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.